The New Iraqi Journal of Medicine 2006 2(1):11-14 Anatomy

Double extensor pollicis longus muscle and its clinical

significance
Srijit Das, Associate Professor
Department of Anatomy, Maulana Azad Medical College
190 RPS Flats, Sheikh Sarai Phase-I. New Delhi-110017 India
Tel: 91-11-9811974702
E-mail: das_srijit23@rediffmail.com.
Rajesh Suri ,Professor
Department of Anatomy, Vardhman Mahavir Medical College
New Delhi, India.
Vijay Kapur, Former Director Professor & HOD
Department of Anatomy, Maulana Azad Medical College, New Delhi, India

Abstract
Background: The Extensor Pollicis
Longus (EPL) is an important muscle
producing the extension of the thumb.
There are few reports on double EPL
muscle in literature. The present study
reports the presence of double EPL
muscle with its morphological
description and also highlights its
clinical significance.
Materials and Methods: We dissected
50 upper limbs in the department of
anatomy to observe the variations of the
extensor muscles of the forearm. The
anomaly of double EPL was studied in
detail and appropriate photograph was
taken.
Results: Double EPL muscle was
observed in a left upper limb of a 37
year old male cadaver. The two muscles
had its origin from the posterior surface
of the shaft of the ulna and interosseous
membrane and displayed a common
insertion into the base of distal phalanx
of the thumb.
Conclusion: The presence of double
EPL muscle may be important for
academic purpose and clinical studies
considering the fact that EPL tendon is
used for tendon transfer. The prior
knowledge of such anomalies may be
important during Surgeries for hand
trauma.
Key Words: Extensor Pollicis Longus,
double, accessory, tendon, anomaly,
variations, abnormalities.
Introduction
The EPL muscle has been known to
exhibit variations. Interestingly, the
incidence of the variations of the
extensor tendons has been found to be
less common on the radial side than on
the ulnar side [1]. There are some reports
on the presence of double EPL muscle
[2,3]. Variations of EPL may be in the
form of an individual muscle belly

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which may completely separate from the
common extensor tendons having a
proper tendinous insertion [4]. It is often
necessary to be aware of the anatomical
previous research study had described
accessory EPL tendon in a patient which
resulted in wrist pain [6].Considering the
fact that an incidence of 26% cases
having double EPL tendons have been
reported, the clinical importance of this
anomaly cannot be neglected
[7]. A previous research report had
described an accessory EPL located
between the normal EPL and the
Extensor Indicis Proprius muscle [8].
The anatomical knowledge of such
anomalous muscle may be important for
surgeons. The present study describes in
detail a case of double EPL muscle and
discusses its clinical significance
Awareness of the normal and abnormal
topographical anatomy of the extensor
muscles of the hand may be important
during tendoplasty, tendon transfer
operations and during decompression for
the treatment of de Quervain’s
tenosynovitis.
Materials and Methods
Fifty upper limbs from formalin fixed
cadavers in the Anatomy dissection hall
were taken for the study. The extensor
compartment of the forearm was
dissected. The tendons of these muscles
were displayed and studied in detail.
Any anomalies were looked for and
appropriate photograph was taken
(Fig.1).
Results
Double EPL muscle was observed in the
left upper limb of a 37 year old male
cadaver. There were two muscle bellies
of EPL (marked as ‘a’ & ‘b’ in Fig.1).
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variations of the extensor tendons while
performing tendon transfer and treating
traumatized hand [5]. A
One originated from the posterior
surface of the shaft of ulna and the other
from interosseous membrane. These two
slender muscle bellies became
tendinous, about 4 cm proximal to the
wrist. The two tendons traversed deep to
the extensor retinaculum and were found
to unite at the dorsum of proximal
phalanx of the thumb to be inserted into
the distal phalanx.
Discussion
Standard anatomy textbooks do not
mention in detail the incidence of
anomalies of EPL especially double EPL
muscle. There are reports of
supplementary extensor tendons of the
hand [2, 9, 10, 11].It may be an
individual muscle belly separated from
the common extensor tendons having an
additional insertion as an additional
tendon [4]. Interestingly, the anomalies
of the extensor tendons have been found
more on the radial side compared to the
ulnar side [1]. In the present study also,
the anomaly involves the EPL muscle
which is on the radial side of the
forearm. The variations of extensor
tendons of the thumb have been reported
while performing operations and cadaver
dissections [12]. On extensive review of
literature we encountered two cases of
double EPL tendon [2, 3]. There are also
reports of abnormal origin and insertion
of extensors of the thumb [13, 14, 15]. In
the present case, the muscle originated
as two separate bellies, traversed deep to
the extensor retinaculum to be inserted
as a single tendon into the base of the
distal phalanx. Additional extensor of
the thumb, having their own origin,
insertion and separate belly is an
extremely rare entity[16]. Such
anomalous muscles may be incidental
finding during cadaver dissection or
developmental in origin. It has been
suggested that an accessory long
extensor tendon to the thumb may be
regarded as a primitive remnant [1].
A previous researcher had stated that
phylogenetically the accessory EPL in
human beings can be traced to primates
[18]. The explanation for such anomalies
may be related to a shift of the deep
extensor sheet of muscle to the radial
side as seen in rhesus monkeys and
baboons [1].
Conclusion
The presence of two tendons of EPL
could be physiological advantage in case
of injury to one. It has been documented
earlier that rupture of the EPL may be
associated with chronic tenosynovitis
caused be repetitive activity [19]. The
awareness of the variations of the
extensor tendons is important while
decompressing the compartment for de
Quervain’s tenosynovitis [10]. We as
anatomists opine that awareness of
anomalous extensor muscles of the hand
may be important for surgeons while
carrying out reconstructive procedures in
the hand region.
Acknowledgement: The authors express
their sincere thanks to Dr. Aamir Al Mosawi
Honorable Editor, The New Iraqi Journal of
Medicine for the excellent support.
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operations. The anomalous course of
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associated with pain [17]. The presence
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